Referring to the Ombudsman

Prepare your case well

The introduction of a request for mediation implies a certain formalism.

To facilitate the processing of your application, your file must include:

• The mediation request form  with your identity, your contact details as well as those of the insurance company concerned and a summary of the dispute;
• Exchanges of letters with the insurance company relating to the dispute;
• The copy or copies of the contract(s) concerned in your dispute;
• All the documents you deem useful for the investigation of your case.

Depending on your choice, you can submit your application either by :
– Digital form via the online form ;
– Downloadable postal form via the form to be downloaded below;

Form to refer to the Ombudsman online

Form to refer to the Ombudsman by post

Together, let’s take responsible actions!
At ACA, we are concerned about the environment, that’s why we invite you to use the paper form only if necessary.

Do you prefer to use the paper form? If so, please download the form below, complete it and send it back by post:

ACA
c/o Médiateur en Assurance
B.P. 448
L-2014 LUXEMBOURG